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7405 N Cedar Ave Suite 102 Fresno CA 93720-3838 | |
| (559) 432-4948 | |
| (559) 432-4037 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7405 N Cedar Ave, Fresno, California |
| Authorized Official Name and Position | Christopher F. Wong (CEO/PRESIDENT) |
| Authorized Official Contact | 5594324948 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7405 N Cedar Ave Suite 102 Fresno CA 93720-3838 Ph: (559) 432-4948 | 7405 N Cedar Ave Suite 102 Fresno CA 93720-3838 Ph: (559) 432-4948 |
| NPI Number | 1144753807 |
|---|---|
| Provider Enumeration Date | 04/09/2017 |
| Last Update Date | 04/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144753807 | NPI | - | NPPES |
| 1689884223 | Other | CA | MEDICARE ORDERING AND REFERRING PROVIDER |
| 1881805836 | Other | CA | MEDICARE ORDERING AND REFERRING PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 31543 (California) | Primary |
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